Treasury Flags $17.5 Billion in Suspected Health Care Fraud

The Treasury Department says financial institutions reported approximately $17.5 billion in suspicious activity potentially linked to health care fraud during a one-year review period. Treasury emphasized that the figure is not a confirmed measure of fraud losses or taxpayer losses.

FinCEN, Treasury’s financial-crimes bureau, reviewed 5,702 Bank Secrecy Act reports filed between March 1, 2025, and February 28, 2026. The agency announced its findings on September 9, 2026, as part of an effort to help investigators and health care agencies identify possible schemes involving Medicare, Medicaid and private insurance.

What the $17.5 billion figure represents

The total comes from suspicious-activity reports that banks and other financial institutions file when transactions raise potential money-laundering or financial-crime concerns. The reports are investigative leads, not final findings that a crime occurred.

FinCEN said the amount includes completed and attempted transactions, money moving into and out of accounts, transfers between accounts, and activity that may have been reported more than once through duplicate, amended or continuing filings. Some transactions could also have been legal. The review period refers to when reports were filed, and the underlying activity may have occurred earlier.

For that reason, the $17.5 billion figure should not be read as a confirmed fraud total, a measure of government payments improperly taken or an estimate of taxpayer losses. The reports also do not represent a count of unique perpetrators, cases or confirmed schemes.

Activity identified across the country

FinCEN said the reports involved subjects with addresses in all 50 states, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands. About 1.5% of approximately 13,000 subject addresses were foreign. FinCEN cautioned that addresses may appear in multiple reports, so the figures do not necessarily represent unique people or organizations.

The possible schemes involved public programs and private insurance, sometimes in combination. Medicare and Medicaid were named in about 38% of the reports, while other reports involved private insurers or mixed funding sources.

Home health care was the most frequently identified provider category. It appeared in more than 21% of all reports and in nearly 32% when reports involving possible Medicaid-eligibility fraud in Puerto Rico were excluded.

That finding does not mean home health providers as a group were engaged in wrongdoing. It identifies a provider category that appeared frequently in the financial reports and may help investigators prioritize follow-up work.

Depository institutions filed about 89% of the reports and accounted for nearly 87% of the reported suspicious-activity amount, according to FinCEN.

How agencies are using the information

The Treasury announcement came one day after the Centers for Medicare & Medicaid Services said it had identified and barred 11 medical-equipment suppliers from receiving future Medicare Advantage and Part D payments. CMS said the suppliers were linked to more than $3.4 billion in suspected billing activity in 2025 and 2026.

CMS said the suppliers had billed for equipment for deceased beneficiaries or for people who did not request or receive it. The agency placed the suppliers on the Medicare Preclusion List and used payment-suspension authority in some cases. Those are administrative payment-integrity actions, not criminal convictions.

The agencies’ approach combines financial information from banks with claims data and enrollment controls. Those tools can help identify questionable billing, interrupt payments and direct cases to investigators, but further proceedings are needed to determine whether individual providers or transactions violated the law.

Why oversight remains difficult

The Government Accountability Office said an estimated $1.2 trillion went to federally funded programs administered by state and local governments in fiscal year 2025. Its review of 20 major programs found that those programs accounted for about $1.1 trillion in federal obligations and that their decentralized structure can leave them vulnerable to fraud schemes involving recipients, providers, contractors and other participants.

GAO also found that only five of the 20 programs had documented evidence consistent with identifying and assessing fraud risks to prioritize action. The other 15 did not have such documented evidence.

What happens next

The next steps may include investigations, payment suspensions, provider exclusions, civil recoveries and criminal charges. Those outcomes would establish what portion of the suspicious activity, if any, involved proven misconduct or recoverable losses.

For now, FinCEN’s report is best understood as a nationwide financial-intelligence signal: a large volume of reported transactions connected to possible health care fraud, not a final accounting of fraud committed or money lost.

Sources

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